Status: Active: Approved (STU)

Introduction

This profile sets out the expectations for the interweave Height observation resource. Care connect do not have a profile for this observation, and therefore the base for this profile is the Interweave-Observation. We stipulate the use of SNOMED concept codes where possible and have removed the component field. This is to ensure that the valueQuantity field is used to provide the result.

Mandatory fields

The following mandatory fields are defined:

1. status – Fixed value of ‘final’. We use the required binding supplied by care connect for the observation status. As stated in the introduction, only finalised observations should be shared.

2. category – Fixed value of ‘vital-signs’.

3. code – Fixed value of SCT: 50373000 (Body height measure) & LOINC: 8302-2(Body Height).

4. subject – Reference to the patient who is the subject of this measurement.

5. effective – An important field to provide details of the time/time period during which the observation was taken.

6. valueQuantity – The actual result recorded.

Must Support fields

In addition the following fields are “Must Support” - ie they must be populated if relevant and known.

1. identifier – A Local Id should be provided, such that could be quoted if manually getting in touch to find out more.

2. performer – We limit this field to reference practitioner resources only. The organization responsible for the observation can be obtained via the provenance tag.

3. comment – Comments in addition to the result are often recorded for observations, it is therefore important to provide this field when available to give the consumer the full result information.

Optional fields

Other fields are optional and may be populated if known - on the understanding that not all data consumers will necessarily make use of them. Points of note include:

• context – Optional link to an encounter resource.

• method – Option to provide the mechanism used to perform the observation

• device – Opportunity to provide a link to a device resource from which was used to obtain the observation.

• related – To reduce complexity, we limit the related field’s usage to only allow links to observation resources, from which the primary observation’s value was derived. E.g. An observation may have a value which is a score, and that score may have been derived from several other observations.

Discouraged or Removed fields

• Component – Removed to aid the data consumer, we ask that the result is provided in the valueQuantity field and not as a component.

• basedOn – This field is discouraged as it does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.

• issued – This field has been removed as this information can be taken from the mandatory meta.lastUpdated field, and to also avoid any confusion with the other date fields.

• interpretation
• referenceRange
• specimen
• dataAbsentReason
• bodySite

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
• All

This structure is derived from InterweaveObservation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	InterweaveObservation	Measurements and simple assertions
extension:reason		0..0
extension:valuePrecision		0..0
status		1..1	code	Fixed value of ‘final’. Fixed Value: final
category		1..1	CodeableConcept	Classification of type of observation
coding:snomedCT		0..0
category:observationCategory		1..1	CodeableConcept	Classification of type of observation
coding		0..*	Coding	Code defined by a terminology system
code		1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display		1..1	string	Representation defined by the system Fixed Value: Vital Signs
code		1..1	CodeableConcept	Type of observation (code / type) Binding: Vital Signs (preferred)
coding		1..*	Coding	Code defined by a terminology system
coding:snomedCT		0..1	Coding	Code defined by a terminology system
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 50373000
display		1..1	string	Representation defined by the system Fixed Value: Body height measure
coding:loinc		1..1	Coding	Code defined by a terminology system
system		0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		0..1	code	Symbol in syntax defined by the system Fixed Value: 8302-2
display		0..1	string	Representation defined by the system Fixed Value: Body height
effective[x]		1..1	dateTime	This is the date/time at which the observation was taken.
value[x]		1..1	Quantity	Actual result
dataAbsentReason		0..0
interpretation		0..0
bodySite		0..0
specimen		0..0
referenceRange		0..0
component		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.code	preferred	Vital Signs

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	InterweaveObservation	Measurements and simple assertions
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Business Identifier for observation
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	Fixed value of ‘final’. Binding: ObservationStatus (required) Fixed Value: final
Slices for category	S	1..1	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.system Binding: Observation Category Codes (preferred): Codes for high level observation categories.
category:All Slices				Content/Rules for all slices
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
category:observationCategory		1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (required): Codes for high level observation categories.
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/observation-category
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display	Σ	1..1	string	Representation defined by the system Fixed Value: Vital Signs
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: Vital Signs (preferred)
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	SΣ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 50373000
display	Σ	1..1	string	Representation defined by the system Fixed Value: Body height measure
coding:loinc	Σ	1..1	Coding	Code defined by a terminology system
system	Σ	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	0..1	code	Symbol in syntax defined by the system Fixed Value: 8302-2
display	Σ	0..1	string	Representation defined by the system Fixed Value: Body height
subject	SΣ	1..1	Reference(CareConnectPatient1)	The patient whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
display	Σ	1..1	string	Description of the referenced resource
effective[x]	SΣ	1..1	dateTime	This is the date/time at which the observation was taken.
performer	SΣ	0..*	Reference(CareConnect-Practitioner-1)	Who is responsible for the observation.
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
display	Σ	1..1	string	Description of the referenced resource
value[x]	SΣC	1..1	Quantity	Actual result
comment	S	0..1	string	Comments about the result
related	SΣ	0..*	BackboneElement	Resources related to this observation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: derived-from
target	S	1..1	Reference(CareConnect-Observation-1)	we limit the related field’s usage to only allow links to observation resources, from which the primary observation’s value was derived. E.g. An observation may have a value which is a score, and that score may have been derived from several other observations.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.meta.tag	example	Common Tags
Observation.meta.tag:Source	example	Common Tags
Observation.meta.tag:Provenance	example	Common Tags
Observation.identifier.use	required	IdentifierUse
Observation.status	required	Fixed Value: final
Observation.category	preferred	Observation Category Codes
Observation.category:observationCategory	required	Observation Category Codes
Observation.code	preferred	Vital Signs
Observation.code.coding:snomedCT	preferred	Fixed Value: SNOMED CT code 50373000
Observation.related.type	required	Fixed Value: derived-from
Observation.component.code	preferred	Care Connect Observation Type
Observation.component.code.coding:snomedCT	preferred	Care Connect Observation Type

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If code is the same as a component code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	InterweaveObservation	Measurements and simple assertions
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Business Identifier for observation
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest)	DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
status	?!SΣ	1..1	code	Fixed value of ‘final’. Binding: ObservationStatus (required) Fixed Value: final
Slices for category	S	1..1	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.system Binding: Observation Category Codes (preferred): Codes for high level observation categories.
category:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
text	Σ	0..1	string	Plain text representation of the concept
category:observationCategory		1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (required): Codes for high level observation categories.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/observation-category
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display	Σ	1..1	string	Representation defined by the system Fixed Value: Vital Signs
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: Vital Signs (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	SΣ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 50373000
display	Σ	1..1	string	Representation defined by the system Fixed Value: Body height measure
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:loinc	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Fixed Value: 8302-2
display	Σ	0..1	string	Representation defined by the system Fixed Value: Body height
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(CareConnectPatient1)	The patient whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context		0..1	Reference(CareConnect-Encounter-1)	The encounter during which this observation is made.
effective[x]	SΣ	1..1	dateTime	This is the date/time at which the observation was taken.
performer	SΣ	0..*	Reference(CareConnect-Practitioner-1)	Who is responsible for the observation.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
value[x]	SΣC	1..1	Quantity	Actual result
comment	S	0..1	string	Comments about the result
method		0..1	CodeableConcept	How it was done Binding: Observation Methods (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
device		0..1	Reference(Device)	Measurement device.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
related	SΣ	0..*	BackboneElement	Resources related to this observation
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: derived-from
target	S	1..1	Reference(CareConnect-Observation-1)	we limit the related field’s usage to only allow links to observation resources, from which the primary observation’s value was derived. E.g. An observation may have a value which is a score, and that score may have been derived from several other observations.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.meta.security	extensible	All Security Labels
Observation.meta.tag	example	Common Tags
Observation.meta.tag:Source	example	Common Tags
Observation.meta.tag:Provenance	example	Common Tags
Observation.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
Observation.identifier.use	required	IdentifierUse
Observation.identifier.type	extensible	Identifier Type Codes
Observation.status	required	Fixed Value: final
Observation.category	preferred	Observation Category Codes
Observation.category:observationCategory	required	Observation Category Codes
Observation.code	preferred	Vital Signs
Observation.code.coding:snomedCT	preferred	Fixed Value: SNOMED CT code 50373000
Observation.method	preferred	Observation Methods
Observation.referenceRange.type	extensible	Observation Reference Range Meaning Codes
Observation.referenceRange.appliesTo	example	Observation Reference Range Applies To Codes
Observation.related.type	required	Fixed Value: derived-from
Observation.component.code	preferred	Care Connect Observation Type
Observation.component.code.coding:snomedCT	preferred	Care Connect Observation Type
Observation.component.dataAbsentReason	extensible	Observation Value Absent Reason
Observation.component.interpretation	extensible	Observation Interpretation Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

Differential View

This structure is derived from InterweaveObservation

Name	Flags	Card.	Type	Description & Constraints
Observation		0..*	InterweaveObservation	Measurements and simple assertions
extension:reason		0..0
extension:valuePrecision		0..0
status		1..1	code	Fixed value of ‘final’. Fixed Value: final
category		1..1	CodeableConcept	Classification of type of observation
coding:snomedCT		0..0
category:observationCategory		1..1	CodeableConcept	Classification of type of observation
coding		0..*	Coding	Code defined by a terminology system
code		1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display		1..1	string	Representation defined by the system Fixed Value: Vital Signs
code		1..1	CodeableConcept	Type of observation (code / type) Binding: Vital Signs (preferred)
coding		1..*	Coding	Code defined by a terminology system
coding:snomedCT		0..1	Coding	Code defined by a terminology system
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 50373000
display		1..1	string	Representation defined by the system Fixed Value: Body height measure
coding:loinc		1..1	Coding	Code defined by a terminology system
system		0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		0..1	code	Symbol in syntax defined by the system Fixed Value: 8302-2
display		0..1	string	Representation defined by the system Fixed Value: Body height
effective[x]		1..1	dateTime	This is the date/time at which the observation was taken.
value[x]		1..1	Quantity	Actual result
dataAbsentReason		0..0
interpretation		0..0
bodySite		0..0
specimen		0..0
referenceRange		0..0
component		0..0
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet
Observation.code	preferred	Vital Signs

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	InterweaveObservation	Measurements and simple assertions
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Business Identifier for observation
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
status	?!SΣ	1..1	code	Fixed value of ‘final’. Binding: ObservationStatus (required) Fixed Value: final
Slices for category	S	1..1	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.system Binding: Observation Category Codes (preferred): Codes for high level observation categories.
category:All Slices				Content/Rules for all slices
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
category:observationCategory		1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (required): Codes for high level observation categories.
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/observation-category
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display	Σ	1..1	string	Representation defined by the system Fixed Value: Vital Signs
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: Vital Signs (preferred)
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	SΣ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 50373000
display	Σ	1..1	string	Representation defined by the system Fixed Value: Body height measure
coding:loinc	Σ	1..1	Coding	Code defined by a terminology system
system	Σ	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code	Σ	0..1	code	Symbol in syntax defined by the system Fixed Value: 8302-2
display	Σ	0..1	string	Representation defined by the system Fixed Value: Body height
subject	SΣ	1..1	Reference(CareConnectPatient1)	The patient whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
display	Σ	1..1	string	Description of the referenced resource
effective[x]	SΣ	1..1	dateTime	This is the date/time at which the observation was taken.
performer	SΣ	0..*	Reference(CareConnect-Practitioner-1)	Who is responsible for the observation.
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
display	Σ	1..1	string	Description of the referenced resource
value[x]	SΣC	1..1	Quantity	Actual result
comment	S	0..1	string	Comments about the result
related	SΣ	0..*	BackboneElement	Resources related to this observation
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: derived-from
target	S	1..1	Reference(CareConnect-Observation-1)	we limit the related field’s usage to only allow links to observation resources, from which the primary observation’s value was derived. E.g. An observation may have a value which is a score, and that score may have been derived from several other observations.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.meta.tag	example	Common Tags
Observation.meta.tag:Source	example	Common Tags
Observation.meta.tag:Provenance	example	Common Tags
Observation.identifier.use	required	IdentifierUse
Observation.status	required	Fixed Value: final
Observation.category	preferred	Observation Category Codes
Observation.category:observationCategory	required	Observation Category Codes
Observation.code	preferred	Vital Signs
Observation.code.coding:snomedCT	preferred	Fixed Value: SNOMED CT code 50373000
Observation.related.type	required	Fixed Value: derived-from
Observation.component.code	preferred	Care Connect Observation Type
Observation.component.code.coding:snomedCT	preferred	Care Connect Observation Type

Constraints

Id	Grade	Path(s)	Details	Requirements
dom-1	error	Observation	If the resource is contained in another resource, it SHALL NOT contain any narrative : contained.text.empty()
dom-2	error	Observation	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Observation	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource : contained.where(('#'+id in %resource.descendants().reference).not()).empty()
dom-4	error	Observation	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()
obs-6	error	Observation	dataAbsentReason SHALL only be present if Observation.value[x] is not present : dataAbsentReason.empty() or value.empty()
obs-7	error	Observation	If code is the same as a component code then the value element associated with the code SHALL NOT be present : value.empty() or component.code.where( (coding.code = %resource.code.coding.code) and (coding.system = %resource.code.coding.system)).empty()

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Observation	C	0..*	InterweaveObservation	Measurements and simple assertions
id	SΣ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
versionId	SΣ	0..1	id	Version specific identifier
lastUpdated	SΣ	0..1	instant	MANDATORY except in Contained Resources. When the resource version last changed.
profile	SΣ	0..*	uri	Profiles this resource claims to conform to. Should list (i) this profile (ii) underlying CareConnect profile
security	Σ	0..*	Coding	DISCOURAGED - may not be honoured by Data Consumers Binding: All Security Labels (extensible): Security Labels from the Healthcare Privacy and Security Classification System.
Slices for tag	Σ	0..*	Coding	Tags applied to this resource Slice: Unordered, Open by value:system Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
tag:Source	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The Data Provider Id (and display text) of the system supplying the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Source
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The Data Provider Id of the system supplying the data
display	SΣ	1..1	string	Name of the system supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
tag:Provenance	SΣ	0..1	Coding	MANDATORY except in Contained Resources. The ODS Code (and display text) of the organisation responsible for the data Binding: Common Tags (example): Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones"
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: https://yhcr.nhs.uk/Provenance
version	Σ	0..1	string	Version of the system - if relevant
code	SΣ	1..1	code	The ODS Code of the organisation responsible for the data
display	SΣ	1..1	string	Name of the organisation supplying the data
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
implicitRules	?!Σ	0..1	uri	DISCOURAGED - may not be honoured by Data Consumers
language		0..1	code	English is assumed (not currently a multi-lingual implementation) Binding: Common Languages (extensible): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	DISCOURAGED - the preferred approach is to offer structured data fields which a Data Consumer can then render and present in a manner most suited to its users
contained		0..*	Resource	Contained, inline Resources
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
identifier	SΣ	0..*	Identifier	Business Identifier for observation
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	0..1	code	usual | official | temp | secondary (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .
type	Σ	0..1	CodeableConcept	Description of identifier Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
system	Σ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	Σ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(CareConnect-Organization-1)	Organization that issued id (may be just text)
basedOn	Σ	0..*	Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ProcedureRequest | ReferralRequest)	DISCOURAGED - This field does not appear to provide information which would be beneficial in a shared care record. It also allows references to a raft of request/order resources which introduces a lot of complexity for a data consumer.
status	?!SΣ	1..1	code	Fixed value of ‘final’. Binding: ObservationStatus (required) Fixed Value: final
Slices for category	S	1..1	CodeableConcept	Classification of type of observation Slice: Unordered, Open by value:coding.system Binding: Observation Category Codes (preferred): Codes for high level observation categories.
category:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
text	Σ	0..1	string	Plain text representation of the concept
category:observationCategory		1..1	CodeableConcept	Classification of type of observation Binding: Observation Category Codes (required): Codes for high level observation categories.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://hl7.org/fhir/observation-category
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: vital-signs
display	Σ	1..1	string	Representation defined by the system Fixed Value: Vital Signs
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
code	SΣ	1..1	CodeableConcept	Type of observation (code / type) Binding: Vital Signs (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:snomedCT	SΣ	0..1	Coding	Code defined by a terminology system Binding: Care Connect Observation Type (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system Fixed Value: 50373000
display	Σ	1..1	string	Representation defined by the system Fixed Value: Body height measure
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:loinc	Σ	1..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	0..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	0..1	code	Symbol in syntax defined by the system Fixed Value: 8302-2
display	Σ	0..1	string	Representation defined by the system Fixed Value: Body height
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(CareConnectPatient1)	The patient whose characteristics (direct or indirect) are described by the observation and into whose record the observation is placed.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
context		0..1	Reference(CareConnect-Encounter-1)	The encounter during which this observation is made.
effective[x]	SΣ	1..1	dateTime	This is the date/time at which the observation was taken.
performer	SΣ	0..*	Reference(CareConnect-Practitioner-1)	Who is responsible for the observation.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	1..1	string	Description of the referenced resource
value[x]	SΣC	1..1	Quantity	Actual result
comment	S	0..1	string	Comments about the result
method		0..1	CodeableConcept	How it was done Binding: Observation Methods (preferred)
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
Slices for coding	Σ	0..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:system
coding:All Slices				Content/Rules for all slices
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
system	Σ	1..1	uri	Identity of the terminology system
version	Σ	0..1	string	Version of the system - if relevant
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
coding:snomedCT	Σ	0..1	Coding	Code defined by a terminology system
id		0..1	string	xml:id (or equivalent in JSON)
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
snomedCTDescriptionID		0..*	(Complex)	The SNOMED CT Description ID for the display URL: https://fhir.hl7.org.uk/STU3/StructureDefinition/Extension-coding-sctdescid
system	Σ	1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code	Σ	1..1	code	Symbol in syntax defined by the system
display	Σ	1..1	string	Representation defined by the system
userSelected	Σ	0..1	boolean	If this coding was chosen directly by the user
text	Σ	0..1	string	Plain text representation of the concept
device		0..1	Reference(Device)	Measurement device.
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations Slice: Unordered, Open by value:url
reference	ΣC	1..1	string	Reference to a resource (could be Contained)
identifier	Σ	0..1	Identifier	If relevant could include an id
display	Σ	0..1	string	If relevant, description of the referenced resource
related	SΣ	0..*	BackboneElement	Resources related to this observation
id		0..1	string	xml:id (or equivalent in JSON)
extension		0..*	Extension	Additional Content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored
type	S	1..1	code	has-member | derived-from | sequel-to | replaces | qualified-by | interfered-by Binding: ObservationRelationshipType (required): Codes specifying how two observations are related. Fixed Value: derived-from
target	S	1..1	Reference(CareConnect-Observation-1)	we limit the related field’s usage to only allow links to observation resources, from which the primary observation’s value was derived. E.g. An observation may have a value which is a score, and that score may have been derived from several other observations.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code
Observation.meta.security	extensible	All Security Labels
Observation.meta.tag	example	Common Tags
Observation.meta.tag:Source	example	Common Tags
Observation.meta.tag:Provenance	example	Common Tags
Observation.language	extensible	Common Languages Additional Bindings Purpose AllLanguages Max Binding
Observation.identifier.use	required	IdentifierUse
Observation.identifier.type	extensible	Identifier Type Codes
Observation.status	required	Fixed Value: final
Observation.category	preferred	Observation Category Codes
Observation.category:observationCategory	required	Observation Category Codes
Observation.code	preferred	Vital Signs
Observation.code.coding:snomedCT	preferred	Fixed Value: SNOMED CT code 50373000
Observation.method	preferred	Observation Methods
Observation.referenceRange.type	extensible	Observation Reference Range Meaning Codes
Observation.referenceRange.appliesTo	example	Observation Reference Range Applies To Codes
Observation.related.type	required	Fixed Value: derived-from
Observation.component.code	preferred	Care Connect Observation Type
Observation.component.code.coding:snomedCT	preferred	Care Connect Observation Type
Observation.component.dataAbsentReason	extensible	Observation Value Absent Reason
Observation.component.interpretation	extensible	Observation Interpretation Codes

Constraints

Id	Grade	Path(s)	Details	Requirements
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() | (children().count() > id.count())
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from InterweaveObservation

Summary

Mandatory: 3 elements
Fixed Value: 8 elements
Prohibited: 9 elements